Root planing is defined by the AAP as “a treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms.”6 This procedure focuses not on identifiable deposits of calculus but on the entire root surface associated with the periodontal pocket. Appearance of the teeth is of great importance to patients, and the polishing procedure can be an excellent way to motivate them to remove plaque biofilm for health as well as appearance. NONSURGICAL PERIODONTAL THERAPY Instructed by Kelli R. Illyes, R.D.H, M.D.H. Plaque biofilm must also be dislodged from all accessible surfaces. The dental hygienist must develop a tactile sense that permits detection of obvious calculus on the teeth. Afterwards, you return to your general dentist, who will place a crown or other restoration on the tooth to protect it … The purpose of prophylaxis is to assist the patient in maintaining and preserving periodontal health. Armitage presented the following information regarding root surface roughness. Connective tissue fibers are disrupted and lysed beneath the epithelium. As the understanding of plaque biofilm as the pathologic agent has grown, various periodontal diseases have been identified with specific microbial organisms. Describe the contributions of magnification with use of loupes, endoscopy, and microscopes to nonsurgical therapy. Gingival curettage, also called closed curettage or nonsurgical gingival curettage (truly a misnomer), was traditionally performed to remove inflamed pocket lining for reasons distinct from periodontal debridement. With simple scaling and ultrasonic cleaning, and some home care instructions, the gum disease will be a thing of the past. Repair after disruption of the junctional epithelium during scaling procedures (not removal, which occurs with surgical excision) is similar to the normal course of events in tissue turnover.25, Inflammatory activity occurs in the underlying connective tissue during the disease process and is also a result of treatment. 5. Scaling may be accomplished with sharp hand instruments or with sonic or ultrasonic instrumentation using powered scaling devices. After periodontal debridement is performed (unless there are systemic complications) periodontal pockets, alveolar bone, periodontal ligament, and epithelium will heal. Although calculus is an inert substance, its role appears to be that of plaque biofilm retention, and its removal is associated with a return to periodontal health, as seen in Figure 13-4. Laser periodontal therapy is one of the latest and most exciting techniques being developed for the treatment of periodontal disease. The cornerstone of management of chronic periodontitis is the non-surgical periodontal treatment. The goals of nonsurgical periodontal therapy must be considered in terms of the immediate treatment goals at the time of the appointment and the long-term goals for the patient. View Video. Curettage had been defined by the AAP as scraping or cleaning the walls of a cavity or surface by means of a curette. To do so, the patient uses oral hygiene procedures and the dental hygienist performs coronal polishing. Animal studies provide strong evidence that these destructive diseases occur in the presence of microbes, but not in animals raised in germ-free environments. Clearly, this requires clinical experience and judgment on the part of the dental hygienist. This practice supports the old notion of “necrotic” root surfaces. Treatment options will focus on non-surgical periodontal therapy. Bacteria repopulate in a specific order, starting with Streptococcus and Actinobacillus species, followed by Veillonella, Bacteroides, Porphyromonas, Prevotella, and Fusobacterium species. Abrasives used during polishing can scratch amalgam, composite resin, and gold restorative materials. Chronic periodontitis is a polymicrobial biofilm infection (Abusleme et al. Specifically, curettage performed by the dental hygienist (legally permitted in some states), properly termed gingival curettage, is limited to closed curettage. In the 1960s, this disease was recognized as different from typical periodontitis because the conventional therapy, which consisted of scaling and root planing in the localized affected areas of the anterior teeth and first molars, could only slow the loss of these teeth. Clinical trials have consistently demonstrated that scaling and root planing reduce gingival inflammation and probing depths and result in gains of clinical attachment in most periodontal patients.13 There are also secondary influences on periodontal health that must be considered. Start studying Perio - Chapter 24 - Nonsurgical Periodontal Therapy. The initial approach for treating gingival and periodontal diseases is debridement of plaque biofilm and calculus through nonsurgical therapeutic techniques. In fact, in some studies, gingivae next to root surfaces that were notched for orientation of researchers after tooth extraction healed uneventfully in the mouth. • Identify the techniques and applications for nonsurgical periodontal therapy procedures. Describe how the. Anatomic and iatrogenic plaque traps, such as overhanging restorations and malposed teeth, must be considered during nonsurgical therapy. The dental hygienist cannot focus solely on the technical aspects of calculus removal. As plaque biofilm ages, the organic matrix and bacterial cells calcify. Studies indicate that endotoxins do not penetrate deeply into cemental surfaces and that retained toxins are associated with missed calculus and plaque rather than diseased cementum. This article presents the essential elements of a PTPincluding diagnosis, treatment planning, implementation of therapy, assessment and monitoring of therapy, insur-ance coding, introduction of the patient to periodontal therapy, and enhanced verbal skills. Although these features are primarily plaque biofilm control problems, the dental hygienist should recognize them, design specific plaque control measures, and refer patients for further treatment. The concept of selective polishing emerged when research on enamel and root surfaces after polishing revealed changes in the hard tissues. • Explain the benefits and indications of antimicrobial adjuncts to nonsurgical therapy. • Define nonsurgical periodontal therapy. This uniform smoothness should be identified. This rationale has been questioned for many years and the procedure is no longer considered standard treatment.21,22. Thus, the rationale for root planing to remove root roughness and achieve glassy, smooth root surfaces is no longer valid. The primary ... among different types of … Inflammation and tissue destruction in conventionally raised animals with oral biota are vastly more widespread and severe.5. The definitions of procedures must be clear and consistent. Kepic and colleagues18 demonstrated residual calculus on most teeth after 45 to 60 minutes of treatment time per quadrant. Dental hygienist performing nonsurgical therapy in the contemporary clinical setting. Experience suggests that the roots in an individual patient’s mouth will feel equally smooth after thorough instrumentation. Controlling Systemic Risk Factors.Several risk factors have well established associations with both periodontal and systemic diseases, such as diabetes, smoking, stress, immunodeficiency, medications, obesity, hormones, and nutrition. • Smooth surfaces promote gingival healing. âRoot planingâ involves cleaning plaque from below the gum line that is most often the culprits in periodontal disease. Although there are adjunct procedures that improve periodontal health, there is no substitute for scaling and root planing to remove local irritants to the tissues. These data indicate that toxins are superficially located on root surfaces and easily removed. The restoration of gingival health is the sum of good plaque control, complete scaling and periodontal debridement, and sufficient time for healing to occur—several months for complete healing of both the epithelium and connective tissue. Calculus adheres to tooth surfaces through pellicular attachment, mechanical locking, and intercrystalline forces. It commonly occurs during nonsurgical periodontal therapy. The effects of nonsurgical periodontal therapy. It varies in crystal composition, type of attachment, and degree of difficulty in removal (see. The only study that attempted to measure root texture with quantifiable profilometer (Micrometrical Manufacturing, Ann Arbor, MI) readings found that the amount of root roughness did not affect plaque biofilm formation. Cortney Annese, RDH, says attention to detail, patient compliance, and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. True or false: nonsurgical therapy is typically done prior to surgical therapy? The restoration of gingival health is the sum of good plaque control, complete scaling and periodontal debridement, and sufficient time for healing to occur—several months for complete healing of both the epithelium and connective tissue.2,3 These goals are summarized in Table 13-2. Within 10 to 21 days, every subject had gingivitis, which resolved in about 1 week when oral hygiene practices were resumed. Studies evaluating plaque biofilm formation on rough root surfaces are equivocal. Normal turnover of cells in the junctional epithelium, which migrate from the apical end to the coronal end, takes about 5 days. It was once thought that tooth surfaces had to be plaque-free to absorb fluoride during fluoride treatments, so polishing of teeth was performed routinely before office fluoride applications. This involves the removal of bacterial plaque and tartar which is present at and below the gum line. For optimal treatment results, systemic risk factors must be modified or eliminated. Soft Tissue Healing After Scaling and Periodontal Debridement. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. This webinar will discuss the diagnosis and treatment planning of periodontal disease. Damage to the gums and bone support around the upper front teeth following the use of a laser. Polishing may have some aesthetic value for patients and may help motivate them to maintain a clean mouth, but it has no proven therapeutic value. 1981, Serino et al. periodontally healthy sites. Air powder polishing removes most extrinsic stains and soft deposits from the exposed surfaces of the teeth. Prophylaxis is a preventive procedure to remove local gingival irritants and includes complete calculus removal followed by root planing. Although some periodontal destruction has been observed in germ-free (gnotobiotic) animal experiments, it tends to be localized and related to the impaction of foreign objects, such as hairs. Extensive root instrumentation is not required beyond the removal of calculus and plaque. Conscientious removal of calculus and plaque biofilm with minimum destruction of cementum, termed periodontal debridement, is justified. In some cases, it could be non-surgical or surgical. The contents of any material used for patient care should be read carefully; this is especially warranted when dealing with the myriad choices available for stain removal. One side was treated with conventional root planing and the other with calculus carefully flicked off and root surfaces polished before the tissue was sutured back in place. 4. Mission Viejo, CA 92691 The numbers of organisms are reduced dramatically and grow back in different proportions. pockets deeper than 5 mm and the ultrasonic instruments performed as well as the hand instruments. Plaque biofilm is the primary causative agent in gingival and periodontal diseases. The appealing notion that rough surfaces would present more of a plaque control problem for patients is borne out by experience with obvious calculus or overhanging restorations. Other terms used to describe nonsurgical periodontal therapy include initial therapy,1 Phase I therapy,2,3 etiotropic phase,2 and periodontal debridement. The quality of the plaque is more important than the quantity, but plaque biofilm is still the causative agent in disease. These new microbiota are similar to those found in, 17: Periodontal Maintenance and Prevention, 5: Calculus and Other Disease-Associated Factors, 10: Treatment Planning for the Periodontal Patient, 18: Prognosis and Results After Periodontal Therapy, Periodontology for the Dental Hygienist 4e, Oral hygiene instruction for daily plaque biofilm control, Significant component of periodontal debridement biofilm, Supragingival and subgingival plaque biofilm removal, Instrumentation techniques to remove or disrupt subgingival biofilm, Identification of plaque-retentive factors, Referral for treatment of plaque-retentive conditions such as poorly fitting restorations and malpositioned teeth, Instrumentation techniques to alter the environment of the pocket wall, if necessary, Identification of occlusion-related factors affecting the periodontium, Selective procedure for supragingival plaque and stain removal, Locally or systemically delivered antimicrobial, antiseptic and antiinflammatory medications, CALCULUS AND BIOFILM REMOVAL (PERIODONTAL DEBRIDEMENT), Provide technique instruction and reinforcement, Ensure adoption of adequate daily oral hygiene procedures, Regular removal of new deposits at subsequent visits. Armitage presented the following information regarding root surface roughness8: 1. It takes considerably longer than healing of epithelium—up to several months. are provided for commonly used terminology found in publications and other communications. An excellent example of the application of the specific plaque hypothesis is the treatment of aggressive periodontitis in its juvenile form. ... Schwarz F, Aoki A, Becker J, Sculean A. Laser application in non-surgical periodontal therapy: A systematic review. The nonsurgical endodontic therapy or root canal removes the inflamed or infected pulp, carefully cleans and shapes the inside of the tooth, then fills and seals the space. Slightly rough root surfaces, those that are scaled and cleaned but not planed in a systematic way to remove cementum and leave glassy surfaces, do not accumulate plaque more rapidly than smoother surfaces. Our practice has made great strides in non-surgical management of periodontal problems. For some patients, systemic antibiotics or antimicrobials may be prescribed to be taken orally, to help treat their periodontal disease. The long-term goal of treatment is to restore gingival health. It is usually accomplished during one appointment and has many facets. Rough surfaces mechanically irritate gingival tissues. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The numbers of organisms are reduced dramatically and grow back in different proportions. In fact, in some studies, gingivae next to root surfaces that were notched for orientation of researchers after tooth extraction healed uneventfully in the mouth. Aim: To describe the kinetics of serum inflammatory markers after a course of treatment comprising surgical and non-surgical treatment of chronic periodontitis (CP). Scaling and root planing is a nonsurgical periodontal treatment that removes built up plaque and tartar from the gum … Dental hygiene procedures with hand instruments or powered scalers adequately accomplish subgingival plaque biofilm removal. Periodontics: Home | Meet Our Staff | Patient Information | Periodontal Disease | Dental Implants Dental hygiene procedures with hand instruments or powered scalers adequately accomplish subgingival plaque biofilm removal. However, the roughness associated with calculus and poor restorations is far greater than the slightly granular texture of calculus-free root surfaces. Rationale for Nonsurgical Periodontal Therapy. In the early stages it may not even be noticeable to you. One size fits all grit paste ignores the science of abrasion, can cause sensitivity, and damage aesthetic restorations. Bacteria live in the mouth and are present around diseased teeth. It is now known that the presence of plaque biofilms does not interfere with the uptake of fluoride by tooth structures. Used to probe the depth of a periodontal pocket, allowing the operator to measure the pocket depth by reading the markings Working end is marked in millimetres to measure periodontal pockets around teeth (can probe depths as small as 0.4 mm) Varieties.
describe the various types of nonsurgical periodontal therapy